在英国,药剂师作为初级保健中的一项新的医疗保健服务正在不断融入普通实践。对服务的评估涉及要求药剂师记录其工作的国家措施,关于全科临床计算机系统,使用电子活动代码。没有国家协议,然而,已经确定了要记录哪些活动。这项研究的目的是试图就基于一般实践的药剂师应记录哪些活动达成共识。
选择e-Delphi方法是因为它是达成共识的优秀技术。该研究始于初始阶段,在该阶段中,对全科临床计算机系统进行了筛选,并与来自两个“全科药剂师”网站的药剂师进行了讨论,确定了81个可能与全科药剂师工作相关的代码。然后,通过电子邮件邀请了29名专家(来自两个站点的药剂师和药学技术人员以及通过国家委员会招募的专家)作为小组参加了三轮e-Delphi问卷调查。在每一轮中,小组成员被要求对代码进行评级或排名,并证明他们的选择是合理的。在每一轮中,小组成员获得了上一轮匿名反馈,其中包括他们的个人选择以及共同小组成员的观点。最终共识(在第3轮中)被定义为至少80%的共识。所有e-Delphi回合的代码注释都集中在一起,并进行了主题分析。
21名个人小组成员参加了研究(第1轮有12个回答,第2轮有18个回答,第3轮有16个回答)。关于守则的评注包括三个主题:挑战和促进者;详细程度;和与筹资有关的活动。达成了十个守则的共识,其中八个与活动有关(一般和特定疾病的药物审查,监测高风险药物和药物和解)和两个患者结果(存在副作用和对药物的满意理解)。
正式的共识方法揭示了基于一般实践的药剂师对活性编码的偏好。研究结果将为政策提供信息,以便将来对基于一般实践的药剂师的活动编码的任何塑造都会考虑药剂师的实际需求和偏好。
In the UK, there is ongoing integration of pharmacists into general practice as a new healthcare service in primary care. Evaluation of the service involves national measures that require pharmacists to record their work, on the general practice clinical computer systems, using electronic activity codes. No national agreement, however, has been established on what activities to record. The purpose of this study was to attempt to reach
consensus on what activities general practice-based pharmacists should record.
The e-Delphi method was chosen as it is an excellent technique for achieving
consensus. The study began with an initial stage in which screening of a general practice clinical computer system and discussion groups with pharmacists from two \'pharmacists in general practice\' sites identified 81 codes potentially relevant to general practice-based pharmacists\' work. Twenty-nine experts (pharmacists and pharmacy technicians from the two sites along with experts recruited through national committees) were then invited by e-mail to participate as a panel in three e-Delphi questionnaire rounds. In each round, panellists were asked to grade or rank codes and justify their choices. In every round, panellists were provided with anonymised feedback from the previous round which included their individual choices along with their co-panellists\' views. Final
consensus (in Round 3) was defined as at least 80% agreement. Commentaries on the codes from all e-Delphi rounds were pooled together and analysed thematically.
Twenty-one individual panellists took part in the study (there were 12 responses in Round 1, 18 in Round 2 and 16 in Round 3). Commentaries on the codes included three themes: challenges and facilitators; level of detail; and activities related to funding.
Consensus was achieved for ten codes, eight of which related to activities (general and disease specific medication reviews, monitoring of high-risk drugs and medicines reconciliation) and two to patient outcomes (presence of side effects and satisfactory understanding of medication).
A formal
consensus method revealed general practice-based pharmacists\' preferences for activity coding. Findings will inform policy so that any future shaping of activity coding for general practice-based pharmacists takes account of pharmacists\' actual needs and preferences.